A pleural chest tube is inserted to treat a patient with tension pneumothorax. The nurse assists the physician as multiple doses of a local anesthetic are administered prior to tube insertion
Which of the following observations by the nurse warrants immediate physician attention? 1. The patient complains of pain during anesthetic injections.
2. The patient's systolic blood pressure changes from 156 to 138 mm hg.
3. The patient's heart rate decreases from 100 beats per minute to 65 beats per minute.
4. The patient's respiratory excursion remains the same.
3
Rationale: A 25 percent drop in baseline heart rate is a sign of systemic anesthetic toxicity. Other symptoms of this complication are tinnitus, slurred speech, thick tongue, and mental confusion. This finding should be reported to the physician to ensure appropriate treatment. Pain is normal with local injections. A slight drop in systolic blood pressure and unchanged respiratory excursion are insignificant physical assessment findings.
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